Below is a detailed in-network plan comparison summary of the CBU medical plans. For more details, including out-of-network benefits, refer to the Summary of Benefits & Coverage for each plan, available in the Documents section.
| Kaiser HMO | Health Net EOA | Health Net PPO | |||
|---|---|---|---|---|---|
| Benefit Summary | |||||
| Network | In-Network Only | In-Network Only | In-Network / Out-of-Network | ||
| Deductible | |||||
| Individual | None | None | $500 / $500 | ||
| Family | None | None | $1,500 / $1,500 | ||
| Medical Out-of-Pocket Maximum | |||||
| Individual | $1,500 | $1,500 | $3,000 / $6,000 | ||
| Family | $3,000 | $3,000 (two-party); $4,500 (family) | $9,000 / $18,000 | ||
| Rx Out-of-Pocket Maximum | |||||
| Individual | Combined with Medical | $2,000 | $2,000 / $2,000 | ||
| Family | Combined with Medical | $4,000 | $4,000 / $4,000 | ||
| Other | |||||
| Office Visits | $20 copay | $20 copay ($40 copay for PPO network) | $20 copay / 40% after deductible | ||
| Specialist Visits | $20 copay | $20 copay ($40 copay for PPO network) | $20 copay / 40% after deductible | ||
| Preventive Care Visits | No copay | No copay | No copay / Not covered | ||
| X-Rays and Lab Tests in a Physician's Office | No copay | No copay | 20% after deductible / 40% after deductible | ||
| Advanced Radiology (MRI, MRA, CT, Pet Scan) | $100 copay | $100 copay | 20% after deductible / 40% after deductible | ||
| Inpatient Hospitalization | $250 per admission | $250 per admission | 20% after deductible / 40% after deductible | ||
| Outpatient Surgery and Services | $250 per procedure | $250 per procedure | 20% after deductible / 40% after deductible | ||
| Emergency Room Services | $100 copay (waived if admitted) | $100 copay (waived if admitted) | 20% + $100 copay (waived if admitted) / Same as In-Network | ||
| Urgent Care | $20 copay | $20 copay | $20 copay / 40% after deductible | ||
| Prescription Drugs (30 day supply for retail and 90 day for mail order) | |||||
| Generic | $10 copay | $10 copay | $15 copay / $15 copay + 50% | ||
| Brand Formulary | $25 copay | $25 copay | $35 copay / $35 copay + 50% | ||
| Brand Non-Formulary | N/A | $40 copay | $55 copay / $55 copay + 50% | ||
| Mail Order: Generic | $20 copay for up to 100-day supply | 2x retail copay | $30 | ||
| Mail Order: Brand Formulary | $50 copay for up to 100-day supply | 2x retail copay | $87.50 | ||
| Mail Order: Brand Non-Formulary | N/A | 2x retail copay | $137.50 | ||
The information contained in this website should in no way be construed as a promise or guarantee of employment. The company reserves the right to modify, amend, suspend, or terminate any plan at any time for any reason. If there is a conflict between the information in this website and the actual plan documents or policies, the documents or policies will always govern. Complete details about the benefits can be obtained by reviewing current plan descriptions, contracts, certificates, policies and plan documents available from your Human Resources Office.